Abstract

Background

Since a decade, low and middle income countries have a rising trend of contracting
their primary healthcare services to NGOs. In Pakistan, public sector often lacks
capacity to effectively & equitably manage the healthcare services. It led the government
to outsource the administration of primary health care services to a semi-autonomous
government entity i.e. Peoples’ Primary Healthcare Initiative (PPHI). This small scale
study has assessed the quality of healthcare services at the contracted Basic Health
Units (BHUs) with the PPHI and compared it with those managed by the local district
government in the province of Sindh.

Methods

A cross-sectional mix methods survey was conducted in November 2011. Two BHUs of each
type were selected from the districts Karachi and Thatta in Sindh province. BHUs were
selected randomly and a purposive sampling technique was used to recruit the study
participants at the two study sites. Focus group discussions were conducted with patients
visiting the facility while in-depth interviews were conducted with service providers.
An observation based resource availability checklist was also administered.

Results

There was a significant difference between the PPHI and the district government administered
BHUs with regard to infrastructure, availability of essential medicines, basic medical
appliances, mini-lab facilities and vehicles for referrals. These BHUs were found
to have sufficient number of trained clinical staff and no punctuality and retention
issues whatsoever. The district government administered BHUs presented a dismal picture
in all the aspects.

Conclusion

Out-sourcing of primary healthcare facilities has resulted in significantly improved
certain aspects quality and responsiveness of primary healthcare services. This strategy
is likely to achieve an efficient and perhaps an equitable healthcare delivery in
low and middle income countries where governments have limited capacity to manage
healthcare services.